Why We Are Working on Medicaid

The church has historically been engaged in caring for the medical needs of the poor. In fact, missions to the poor have often been the catalyst for Christian movements across the ages. From St. Francis to John Wesley to the Salvation Army many of the great movements of Christianity have been dedicated to the poor.

One particular image has stood in my mind. In St. Peter’s Basilica stands a wonderful statue of St. John of God (1495-1550) a Portuguese soldier turned health care worker. John was initially very motivated by martyrdom and rescuing Christians fighting against Muslims, but something changed in his life. Around the age of 40 he was motivated by this deep desire to care for the ill and poor. His life’s work eventually went on to inspire the Hospitaller Order of St. John of God.

This is just one example how renewed relationship with the poor and needy went on to have a multi-generational impact for the poor and sick across the world, all done in the name of Christ. Just think in the United States how many hospitals have the names Methodist, Presbyterian, and how many more are dedicated to various Saints. This is all the legacy of the heavenly movement of God’s people, caring for the poor.

Today, Medicaid financing goes to support patients at faith based hospitals and institutions across the country. While we should be steadfast in keeping the public commitment affordable and zealous in finding new ways to help people towards self-sufficiency, we must also be aware of public expenditures and the way they impact the lives of others. The point is not a strict allegiance to one form of providing for the poor, but ensuring that in any system that the poor and sick are truly cared for.

Medicaid is a federal-state partnership program in the United States. In some states the federal government pays upwards of 80% of the total cost, while in other states the cost share is more in the lower 50%. As you might expect the wealthier the state the less federal commitment (click here for easy chart on the state and federal breakdown for your state). The changes being considered before Congress impact the Traditional Medicaid population prior to Obamacare, not just the Medicaid Expansion. Instead of following on the ground trends in a particular state, the federal government would put a hard stop on their expenditures past a certain amount, leaving the states to pick up the rest.

Kingdom Mission Society is becoming involved in the public policy side of this discussion because of the nature of the proposals on the table for the Traditional and Expanded Medicaid recipients. The primary way being discussed to reduce cost is a simple cut in the federal commitment.

More generally in healthcare, KMS broadly supports reforms that reduce costs on family and allow more tools for families and small businesses to afford healthcare.

Medicaid is a primary mechanism to provide basic coverage for the elderly, individuals and families. Current proposals before the U.S. Congress shift costs too substantially on states like Alaska, Alabama, West Virginia, Montana and others—states where meeting their year-to-year budgets are difficult enough. Medicaid is a top #1 or #2 budget item in most states, often rivaling public education as an expense.

In its current form these proposals would strain many state budgets and force those states to choose which of the sick and poor can’t be helped.

There are other ways to run an efficient and cost-effective social safety net program like Medicaid, which don’t involve non-specific reductions in spending. Those options might include tiering benefits based on health need, or providing a gliding path for those who would are motivated to become more self-sufficient. We believe those options and others ought to be exhausted before costs are shifted too quickly on states with significant consequences to the poor.

KMS is concerned that the debate before the U.S. House and now the U.S. Senate has done very little to actually reform or look at the growing cost of Medicaid, instead an ill-advised per-capita-cap has been the main policy measure discussed. A per-capita-cap is a sort of limit on federal dollars past a certain point of expenditure. So if North Carolina spent $7 billion on Medicaid and the federal government was responsible for $4.4 billion of those dollars and in the next year North Carolina had to spend $8 billion because of a downturn in the economy, the federal government would only contribute $4.4 billion under a cap system, leaving North Carolina to make up the $1 billion shortfall.

Per-capita-cap sounds good in theory, but the truth is that without being specific with reforms, simply limiting federal commitments shift the cost to states and at a time when there are more elderly projected to be on Medicaid as the current boomer generation gets older.

While progressive states may very well raise taxes to continue to offer the same type and kind of benefits, many states with limited fiscal options will be forced to limit eligibility. This is a reform that will fall disproportionately on those least able to handle them, and no amount of flexibility from the Centers for Medicaid and Medicare Services can compensate for this fundamental gap in funding.

Measures like a short-term and long-term stability fund are inadequate to the long term cost shift, and again this way of thinking about Medicaid neither leaves government more efficient nor incentivizes the private sector or the faith based community to think of innovative ways to move people towards self- sufficiency and self-dependence. In fact paying for the premiums of those who might lose coverage out of the stability fund is significantly more expensive for states to administer.

The per capita cap and the quick timetable for ramping down Medicaid Expansion and additional cuts to Traditional Medicaid are of particular concern.

That’s why KMS is busy working with state partners to:

Call the church back to renewed faithfulness in its call towards the sick and the poor.

Providing resources for congregations to educate their own members about how to make effective health care decisions.

Urging that discussions on Medicaid are actual reforms and not simply cost shifting, which for some states would put those on Medicaid at risk.

We are also working to develop local affiliates to continue this work more effectively at the local level.

For KMS this isn’t about situational politics. Presidents and majorities come and go. This is about a long term commitment to the well being of the poor and about helping a wide spectrum of the church live out its missional call to the least of these faithfully. Because of the nature of policies related to the poor that means keeping an eye out on critical changes that will have a disproportionate impact on the least of these and that have an impact on the church to caring for the least and transforming lives through the call of Christ.